Piperaquine/dihydroartemisinin

Piperaquine/dihydroartemisinin
Combination of
PiperaquineAntimalarial
DihydroartemisininAntimalarial
Names
Trade namesDuoCotecxin, Artekin, Eurartesim, others
Other namesDihydroartemisinin/piperaquine phosphate
Clinical data
Main usesMalaria[1]
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Routes of
use		By mouth
Defined daily dosenot established[2]
Legal
Legal status
  • UK: [3]
  • In general: ℞ (Prescription only)

Piperaquine/dihydroartemisinin (DHA/PPQ), sold under the brand name Eurartesim among others, is a fixed dose combination medication used in the treatment of malaria.[4] It is a combination of piperaquine and dihydroartemisinin.[4] Specifically it is used for malaria of the P. falciparum and P. vivax types.[5][6] It is taken by mouth.[5]

Side effects are uncommon.[6] Concerns include the possibility of QT prolongation.[6] Versions are available for use in children.[5] Use in early pregnancy is not recommended.[6] The two medications work by different mechanisms.[6]

Piperaquine/dihydroartemisinin was approved for medical use in Europe in 2011.[5] It is on the World Health Organization's List of Essential Medicines.[4] While it was available for about US$6 per treatment course, efforts are underway as of 2010 to bring the price down one dollar per course.[6] It is commercially available in Africa and Asia.[5] It has been used to treat more than 4.5 million people as of 2017.[5]

Medical uses

It is used to treat uncomplicated malaria including that due to falciparum.[1] It may also be used following injectable treatments for severe malaria.[1]

Dosage

The defined daily dose is not established.[2] In those who weight over 25 kg the dose is 2 to 10 mg/kg DHA and 16 to 27 mg/kg PPQ.[1] While in those 5 to 25 kg the dose is 10 mg/kg DHA and 20 to 32 mg/kg PPQ. Treatment is once per day for three days.[1]

Pharmacology

Dihydroartemisinin (also known as dihydroqinghaosu, artenimol or DHA) is a drug used to treat malaria. Dihydroartemisinin is the active metabolite of all artemisinin compounds (artemisinin, artesunate, artemether, etc.) and is also available as a drug in itself. It is a semi-synthetic derivative of artemisinin and is widely used as an intermediate in the preparation of other artemisinin-derived antimalarial drugs.

Piperaquine is an antimalarial drug, a bisquinoline first made in the 1960s, and used extensively in China and Indochina as prophylaxis and treatment during the next 20 years. Usage declined in the 1980s as piperaquine-resistant strains of P. falciparum arose and artemisinin-based antimalarials became available. The combination dihydroartemisinin-piperaquine is an effective antimalarial that is used widely around the world. In South-East Asia, where resistance has emerged towards both artemisinin and piperaquine, the combination is being trialed with a third drug, namely mefloquine.[7]

Piperaquine is characterized by slow absorption and a long biological half-life, making it a good partner drug with artemisinin derivatives which are fast acting but have a short biological half-life.

Society and culture

This product is available in the market of several countries:

  • Artekin (Holleykin)
  • Eurartesim (Sigma Tau; by Good Manufacturing Practices)
  • Diphos (Genix Pharma)
  • Timequin (SAMI Pharma )
  • Duocotecxin (Holley Pharm)
  • Malacur (Elder Pharmaceuticals for SALVAT Laboratories)
  • Ridmal (Ajanta Pharma Limited)

References

  1. 1 2 3 4 5 "DIHYDROARTEMISININ/PIPERAQUINE = DHA/PPQ oral - Essential drugs". medicalguidelines.msf.org. Archived from the original on 28 August 2021. Retrieved 30 August 2020.
  2. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 1 July 2021. Retrieved 11 September 2020.
  3. ↑ "Eurartesim 320 mg/40 mg film-coated tablets - Summary of Product Characteristics (SmPC)". (emc). 10 April 2017. Archived from the original on 13 July 2020. Retrieved 2 May 2020.
  4. 1 2 3 World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. 1 2 3 4 5 6 "Eurartesim EPAR". European Medicines Agency (EMA). 17 September 2018. Archived from the original on 6 August 2020. Retrieved 3 May 2020.
  6. 1 2 3 4 5 6 "Dihydroartemisinin/Piperaquine Application for Inclusion in the 17th WHO Model List of Essential Medicines" (PDF). WHO. November 2010. Archived (PDF) from the original on 28 August 2021. Retrieved 29 June 2017.
  7. ↑ "TRAC II - Mahidol Oxford Tropical Medicine Research Unit". www.tropmedres.ac. Archived from the original on 28 July 2017. Retrieved 28 July 2017.
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